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Abstract：
Background: For peripheral T-cell lymphomas (PTCLs) patients, high-dose therapy combined with autologous peripheral blood stem cell transplantation (HDT/ASCT) has been an alternative treatment option, due to the lack of efficacy from conventional chemotherapy. While not all PTCLs could have benefit in survival from HDT/ASCT. The aim of this study was to evaluate the value of high-dose therapy combined with autologous peripheral blood stem cell transplantation (HDT/ASCT) in Chinese patients with Peripheral T-cell Lymphomas (PTCLs), in order to determine the cohort most suitable to receive HDT/ASCT. Methods: A total of 79 patients with PTCLs who received HDT/ASCT in Peking University Cancer Hospital & Institute from January 2001 to august 2016 were retrospectively analyzed. Results: At a median follow-up time of 23.6 months, the 2-year progression-free survival (PFS) and 2-year overall survival (OS) of the entire cohort were 75.2% and 83.6% respectively. Patients with first complete remission (CR1) (2-year PFS 85.8%, 2-year OS 94.2%) were superior to others in survival. Patients with second complete remission (CR2) had no advantage in survival compared with those with first partial remission (PR1) (2-year PFS: 43.8% vs. 76.2%, p=0.128; 2-year OS: 72.9% vs. 77.1%, p=0.842). In multivariate analysis, response before HDT/ASCT (p=0.001) and LDH before HDT/ASCT (p=0.047) were highly predictive for PFS, while no factors could independently predict OS. Subgroup analysis revealed that HDT/ASCT could improve the survival of patients with angioimmunoblastic T-cell lymphoma (AITL), especially in patients with chemosensitivity. Patients with natural killer / T-cell lymphoma (NKTCL) who received HDT/ASCT with CR1 also had benefit in survival from HDT/ASCT, while nearly 90% of non-CR1 patients appeared bone marrow involvement after HDT/ASCT. Conclusion: Patients who achieved complete remission after first-line therapy, especially with AITL and NKTCL, should strongly be recommended to receive HDT/ASCT. The future prospective trial is warranted.
摘要：
背景：对于外周T细胞淋巴瘤（PTCL）患者，大剂量治疗联合自体外周血干细胞移植（HDT/ASCT）已成为替代治疗选择，由于常规化疗缺乏疗效。虽然并非所有PTCL都可以从HDT/ASCT中获益。本研究的目的是评估大剂量治疗联合自体外周血干细胞移植（HDT/ASCT）在中国外周血T细胞淋巴瘤（PTCL）患者中的价值。以确定最适合接受HDT/ASCT的队列。方法:回顾性分析2001年1月至2016年8月在北京大学肿瘤医院接受HDT/ASCT治疗的79例PTCL患者的临床资料。结果：中位随访时间为23.6个月，整个队列的2年无进展生存期(PFS)和2年总生存期(OS)分别为75.2%和83.6%.首次完全缓解（CR1）患者（2年PFS85.8％，2年OS94.2%)在生存率上优于其他人。与首次部分缓解（PR1）患者相比，第二次完全缓解（CR2）患者的生存率没有优势（2年PFS：43.8％与76.2%,p=0.128；2年OS：72.9%77.1%,p=0.842)。在多变量分析中，HDT/ASCT前的反应（p=0.001）和HDT/ASCT前的LDH（p=0.047）对PFS具有高度预测性，而没有因素可以独立预测OS。亚组分析显示，HDT/ASCT可以提高血管免疫母细胞性T细胞淋巴瘤（AITL）患者的生存率，尤其是对化疗敏感的患者。接受HDT/ASCT和CR1的自然杀伤/T细胞淋巴瘤（NKTCL）患者也受益于HDT/ASCT，而近90%的非CR1患者在HDT/ASCT后出现骨髓受累。结论：一线治疗后完全缓解的患者，尤其是AITL和NKTCL，应强烈建议接收HDT/ASCT。未来的前瞻性试验是有必要的。
